Hyposplenism and Splenectomy

Indications for Splenectomy:

1. Hematological Disorders:
   • Idiopathic Thrombocytopenic Purpura (ITP):
     • Failure of medical therapy.
     • Recurrent or severe bleeding.
     • Refractory disease.
   • Hereditary Spherocytosis:
     • Severe hemolytic anemia.
     • Recurrent or symptomatic gallstones.
   • Thalassemia Major:
     • Severe hypersplenism.
     • Transfusion-dependent anemia.
   • Autoimmune Hemolytic Anemia:
     • Refractory disease.
     • Life-threatening haemolysis.
   • Hairy Cell Leukaemia:
     • Symptomatic splenomegaly.
     • Recurrent infections.
2. Trauma:
   • Splenic Injury:
     • Severe traumatic injury with uncontrolled bleeding.
     • Failure of conservative management.
3. Hematopoietic Disorders:
   • Myeloproliferative Disorders:
     • Symptomatic splenomegaly.
     • Constitutional symptoms.
   • Myelofibrosis:
     • Symptomatic splenomegaly.
     • Constitutional symptoms.
4. Solid Organ Tumours:
   • Splenic Tumours:
     • Benign or malignant tumours of the spleen.
     • Failure of conservative management or chemotherapy.
5. Infectious Diseases:
   • Splenic Abscess:
     • Failure of antibiotic therapy.
     • Septic complications.
   • Hematogenous Spread of Infection:
     • Recurrent septicaemia despite optimal medical treatment.
6. Splenomegaly:
   • Symptomatic Splenomegaly:
     • Pain.
     • Early satiety.
     • Discomfort.
   • Hypersplenism:
     • Cytopenias (thrombocytopenia, leukopenia).
     • Severe anaemia.
7. Immunological Disorders:
   • Felty’s Syndrome:
     • Severe rheumatoid arthritis with associated splenomegaly and neutropenia.
     • Failure of medical therapy.
8. Preventive Measures:
   • Splenectomy in Selected Populations:
     • Sickle cell disease to prevent acute splenic sequestration crises.
     • In patients with inherited bone marrow failure syndromes to decrease risk of haematological malignancies.